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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001308
Report Date: 09/02/2022
Date Signed: 09/02/2022 02:53:10 PM

Document Has Been Signed on 09/02/2022 02:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:GRAVES, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
483001308
ADMINISTRATOR:GRAVES, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 557-7473
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY: 12TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
09/02/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:18 PM
MET WITH:Maria Graves - LicenseeTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Plan of Correction (POC) visit to follow up on a type B deficiency that was cited on 08/11/22. On 08/11/22, the facility was cited because the facility outdoor wooden patio deck that is on the main which is on the second floor had several loose screws, railings and deck posts, and Licensee did not comply with California Code of Regulations (CCR), 102417(g).

During today's inspection, LPA inspected the patio deck which revealed several sections of deck railings were fortified, appeared sturdy and did not contain loose nails or screws; and at least one section was secured to the wall. The Licensee understood she was required to maintain the condition of the facility which included the children’s outdoor play area. LPA cleared the deficiency pertaining to CCR 102417(g) and provided Licensee with a copy of the Letter of Deficiency Citations Cleared.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee. The were no violation(s) of the California Code of Regulations, Title 22; Division 12 cited during today’s visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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